NEW YORK, June 5 (Reuters) - More than three months

after a cyberattack on UnitedHealth Group's ( UNH ) technology

unit, some community health centers, which serve 30 million

low-income and uninsured patients, are still wading through red

tape to receive back payments and struggling with operations

issues.

Change Healthcare, a unit of the largest U.S. health

insurer, processes about 50% of all medical claims in the U.S.,

for around 900,000 doctors, 33,000 pharmacies, 5,500 hospitals

and 600 labs. It also runs other support services like call

centers.

All were shut temporarily after the Feb. 21 ransomware

attack and some, like the medical claims system, took one or two

months to restart.

Reuters spoke with five community health centers or systems

who said they were still reconciling older unpaid medical claims

and tracking down missing payments. Three said they lost

customers due to various hack-related disruptions.

"The negative longer term consequences of this huge

reimbursement disruption are worse for providers whose profit

margin was slim to begin with," said Assistant Professor of

Division of Health Policy & Management Hannah Neprash at the

University of Minnesota Twin Cities.

"That is rural hospitals, safety net hospitals, and

community health centers, any place that treats large shares of

publicly insured patients," Neprash said.

A UnitedHealth ( UNH ) spokesperson declined to comment on continued

reimbursement or call service issues raised by providers. The

company's website says restoration of claims services is

underway or partly complete.

In May testimony to a U.S. Senate committee on the

cyberattack, UnitedHealth ( UNH ) CEO Andrew Witty described the hack as

causing "incredible disruption" across the healthcare system.

The company had distributed $6.5 billion in loans to

providers as of last month. About 34% went to safety net

hospitals and community health centers, Witty wrote in his

testimony to the committee.

OVERTIME

Employees at Nevada Health Centers' 26 locations have

consistently logged over 100 hours of overtime per week filing

additional paperwork to correct patient eligibility or wrongly

denied claims, according to Executive Vice President of Revenue

Cycle and Population Health J.C. Flowers.

The health centers need more labor hours than ever, but may

need to cut jobs as they wrestle with delayed cash flow and seek

overdue payments from insurers, he said.

"It's a real fear when you're used to averaging a million

dollars a month in revenue, and all of a sudden, for the next

eight months, you're going to do $600,000," said Flowers, who

said Nevada Health Centers employs about 150 health

professionals.

With insurance claims backlogged for months, paperwork

justifying each payment makes up the bulk of the cyberattack's

continued burden for providers, according to Terrence

Cunningham, a policy director at the American Hospital

Association.

In an April physician survey published by the American

Medical Association, 91% of respondents said they needed to

commit staff to recouping revenue lost to the hack.

"Organizations have to shift money around to deal with the

aftermath, and it's going to affect them for the entire fiscal

year, at the very least," said Julia Skapik, chief medical

information officer at the National Association of Community

Health Centers. Community Health Centers receive $4.4 billion

in annual government funding.

IMPATIENT PATIENTS

Some providers said their relationships with patients

suffered as a result of disrupted services.

Delaware Valley Community Health, based in Philadelphia, cut

ties with a call center that used Change Healthcare technology.

"We've had to use our own employees now to try and answer

the phones, and we've gotten patients upset with us," said Dr.

A. Scott McNeal, Delaware Valley's CEO, adding that longer waits

led some to hang up without scheduling appointments.

At LCH Health and Community Services, a Kennett Square,

Pennsylvania-based provider, some patients who couldn't easily

fill prescriptions blamed the practice and went elsewhere, Chief

Executive Ronan Gannon said.

That has exacerbated LCH's revenue crunch, as higher paying

privately insured patients left and people without insurance

paying lower fees became a bigger percentage, he said.